Individual
CHARLES L COATS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1330 N COLISEUM BLVD, FORT WAYNE, IN 46805-5526
(260) 447-8982
(260) 447-4483
Mailing address
1330 N COLISEUM BLVD, FORT WAYNE, IN 46805-5526
(260) 447-8982
(260) 447-4483
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01053073A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200231180
—
IN
Enumeration date
08/09/2005
Last updated
06/12/2015
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